Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record
Thomas Rest Haven
Coon Rapids, IA · 57 certified beds · Last Life Safety survey September 18, 2025
CMS Certification Number 165358 · first certified October 1997
Ownership
Independently operated (no chain recorded by CMS) · Government - City/county
No change of ownership on CMS record since January 1, 2016, when the records begin.
Position within IA
19 citations — more than 82% of the 387 certified nursing homes in IA. Compared within IA rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated
The latest survey found 0 citations; the earlier surveys in the window averaged 9.5. With 3 surveys on file this is a direction of travel, not a conclusion.
When is the next survey likely?
The window is open now: August 2026 to October 2026. This facility’s last Life Safety survey was September 2025. Facilities in IA are typically surveyed 11–13 months after the last one (median 12), measured over 700 consecutive surveys in the last two years of CMS records.
A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured
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Emergency preparedness
11 of the 19 citations on file are Emergency Preparedness E-tags. E-tags are cited under 42 CFR §483.73 and concern the emergency plan, training, drills, communications and supplies. Nationally about half of certified facilities have at least one. The Emergency Preparedness Index
Physical environment (health survey)
5 physical-environment citations on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 19 Life Safety citations above. The Physical Environment Index
How that compares
Compared with the median facility in IA, and nationally. Surveyors differ markedly between states, so the IA figure is the meaningful one.
| Measure | Citations |
|---|---|
| This facility | 19 |
| Median facility in IA | 12 |
| Median facility nationally | 11 |
Survey history
| Survey date | Citations |
|---|---|
| July 27, 2023 | 4 |
| October 17, 2024 | 15 |
| September 18, 2025 | 0 |
Most-cited tags
| Tag | What the surveyor checks | Times cited | Last cited |
|---|---|---|---|
| E-0039 | Conduct testing and exercise requirements. | 2 | 2024-10-17 |
| E-0026 | Establish roles under a Waiver declared by secretary. | 2 | 2024-10-17 |
| E-0007 | Address patient/client population and determine types of services needed. | 1 | 2024-10-17 |
| K-0923 | Have proper medical gas storage and administration areas. | 1 | 2023-07-27 |
| E-0033 | Establish methods for sharing information. | 1 | 2024-10-17 |
| K-0711 | Provide a written emergency evacuation plan. | 1 | 2024-10-17 |
| K-0374 | Install smoke barrier doors that can resist smoke for at least 20 minutes. | 1 | 2024-10-17 |
| E-0006 | Conduct risk assessment and an All-Hazards approach. | 1 | 2024-10-17 |
What the citations cover
- Emergency Preparedness Deficiencies 11
- Gas, Vacuum, and Electrical Systems Deficiencies 4
- Smoke Deficiencies 3
- Miscellaneous Deficiencies 1
| Category | Citations |
|---|---|
| Emergency Preparedness Deficiencies | 11 |
| Gas, Vacuum, and Electrical Systems Deficiencies | 4 |
| Smoke Deficiencies | 3 |
| Miscellaneous Deficiencies | 1 |
Every citation on file
As published by CMS, newest survey first. Descriptions are CMS’s own wording.
October 17, 2024 — 15 citations
| Tag | What the surveyor checks | Status |
|---|---|---|
| E-0004 | Develop and maintain an Emergency Preparedness Program (EP). | Deficient, Provider has date of correction (November 14, 2024) |
| E-0006 | Conduct risk assessment and an All-Hazards approach. | Deficient, Provider has date of correction (November 20, 2024) |
| E-0007 | Address patient/client population and determine types of services needed. | Deficient, Provider has date of correction (November 14, 2024) |
| E-0009 | Include a process for Emergency Preparedness collaboration. | Deficient, Provider has date of correction (November 26, 2024) |
| E-0015 | Address subsistence needs for staff and patients. | Deficient, Provider has date of correction (November 14, 2024) |
| E-0024 | Establish policies and procedures for volunteers. | Deficient, Provider has date of correction (November 20, 2024) |
| E-0026 | Establish roles under a Waiver declared by secretary. | Deficient, Provider has date of correction (November 26, 2024) |
| E-0033 | Establish methods for sharing information. | Deficient, Provider has date of correction (November 14, 2024) |
| E-0039 | Conduct testing and exercise requirements. | Deficient, Provider has date of correction (November 14, 2024) |
| K-0346 | Follow proper procedures when the fire alarm was out of service for more than 4 hours. | Deficient, Provider has date of correction (November 14, 2024) |
| K-0354 | Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Deficient, Provider has date of correction (November 14, 2024) |
| K-0374 | Install smoke barrier doors that can resist smoke for at least 20 minutes. | Deficient, Provider has date of correction (November 14, 2024) |
| K-0711 | Provide a written emergency evacuation plan. | Deficient, Provider has date of correction (November 14, 2024) |
| K-0918 | Have generator or other power source capable of supplying service within 10 seconds. | Deficient, Provider has date of correction (November 14, 2024) |
| K-0921 | Ensure that testing and maintenance of electrical equipment is performed. | Waiver has been granted (November 26, 2024) |
July 27, 2023 — 4 citations
| Tag | What the surveyor checks | Status |
|---|---|---|
| E-0026 | Establish roles under a Waiver declared by secretary. | Deficient, Provider has date of correction (September 2, 2023) |
| E-0039 | Conduct testing and exercise requirements. | Deficient, Provider has date of correction (September 2, 2023) |
| K-0920 | Ensure proper usage of power strips and extension cords. | Deficient, Provider has date of correction (September 2, 2023) |
| K-0923 | Have proper medical gas storage and administration areas. | Deficient, Provider has date of correction (September 2, 2023) |
Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.